Healthcare Provider Details

I. General information

NPI: 1841956398
Provider Name (Legal Business Name): VICTORIA THOMPSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SE 7TH ST
MOORE OK
73160-6767
US

IV. Provider business mailing address

2220 SE 7TH ST
MOORE OK
73160-6767
US

V. Phone/Fax

Practice location:
  • Phone: 405-403-6075
  • Fax: 405-951-9923
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19013
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19013
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: